The latest medical research on General Practice (Family Medicine)
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about general practice (family medicine) gathered by our medical AI research bot.
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Chronic fatigue syndrome: progress and possibilities.Medical Journal of Australia
Chronic fatigue syndrome (CFS) is a prevalent condition affecting about one in 100 patients attending primary care. There is no diagnostic test, va...
Cognitive, functional, physical, and nutritional status of the oldest old encountered in primary care: a systematic review.BMC Family Practice
The oldest old (individuals over 90 years) are a fast-growing population. Characterizing their specificity would be helpful to adapt health care. This study aimed to characterize the cognitive, functional, nutritional, and physical status of individuals over 90.
We conducted a systematic review of cross-sectional or cohort studies of individuals aged 90 years old or more, living at home or in a nursing home, in April 2018. Two reviewers selected eligible articles, extracted data, and evaluated the risk of bias (assessed by the Newcastle-Ottawa Scale).
The search strategy identified 3086 references; 35 articles were included referring to 8 cross-sectional and 27 longitudinal studies. Dementia was diagnosed in 30-42.9% of study participants, cognitive impairment in 12-50%, and 31-65% had no cognitive impairment. In terms of activities of daily living, 14-72.6% of individuals had no difficulty, 35.6-38% had difficulty, and 14.4-55.5% were dependent. For instrumental activities of daily living, 20-67.9% needed help. Regarding nutritional status, the Mini Nutritional Assessment Short Form mean score ranged from 10.3 (SD: 1.8) to 11.1 (SD: 2.4). Eight to 32% of individuals could not stand up from a chair, 19-47% could stand without the use of their arms; and 12.9-15% were not able to walk 4 m.
These results suggest a heterogeneous population with a certain proportion of oldest old with a low level of disability. These findings suggest that a specific approach in the care of the oldest old could help prevent disability.
Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study.BMC Family Practice
The National Health Insurance Administration of Taiwan has introduced several pay-for-performance programs to improve the quality of healthcare. This study aimed to provide government with evidence-based research findings to help primary care physicians to actively engage in pay-for-performance programs.
We conducted a questionnaire survey among family physicians with age-stratified sampling from September 2016 to December 2017. The structured questionnaire consisted of items including the basic demographics of the surveyee and their awareness of and attitudes toward the strengths and/or weaknesses of the pay-for-performance programs, as well as their subjective norms, and the willingness to participate in the pay-for-performance programs. Univariate analysis and multivariate logistic regression analysis were performed to compare the differences between family physicians who participate in the pay-for-performance programs versus those who did not.
A total of 543 family physicians completed the questionnaire. Among family physicians who participated in the pay-for-performance programs, more had joined the Family Practice Integrated Care Project [Odds ratio (OR): 2.70; 95% Confidence interval (CI): 1.78 ~ 4.09], had a greater awareness of pay-for-performance programs (OR: 2.37; 95% CI: 1.50 ~ 3.83), and a less negative attitude to pay-for-performance programs (OR: 0.50; 95% CI: 0.31 ~ 0.80) after adjusting for age and gender. The major reasons for family physicians who decided to join the pay-for-performance programs included believing the programs help enhance the quality of healthcare (80.8%) and recognizing the benefit of saving health expenditure (63.4%). The causes of unwillingness to join in a pay-for-performance program among non-participants were increased load of administrative works (79.6%) and inadequate understanding of the contents of the pay-for-performance programs (62.9%).
To better motivate family physicians into P4P participation, hosting effective training programs, developing a more transparent formula for assessing financial risk, providing sufficient budget for healthcare quality improvement, and designing a reasonable profit-sharing plan to promote collaboration between different levels of medical institutions are all imperative.
Effects of a vocational rehabilitation programme on return to work among sick-listed primary health care patients: a population-based matched, case-control study.BMC Family Practice
To evaluate the efficacy of a multidisciplinary vocational programme in sick-listed, primary health care patients as compared to matched non-programme patients.
The design was a 3-year prospective population-based, matched case-control study. It was set in a large primary healthcare centre in the city of Eskilstuna, Sweden. The subjects were 943 sickness-certified patients (482 women and 461 men). 170 high-risk patients and a matched control group (n = 340) with similar risk for not returning to work within expected time, based on propensity score was created. The intervention group passed a multidisciplinary medical assessment and a coordinated vocational programme, while the control group received usual care by their general practitioner. Main outcome was sick leave conclusion and the day when it occurred.
The follow-up time was subdivided into four periods. During the first two periods, days 1-14 and days 15-112 after baseline, the intervention group had a significantly lower sick leave conclusion rate than the control group (hazard ratios, (HR) 0.32, 95% CI 0.20-0.51, p < 0.0001 and 0.47, 95% CI 0.35-0.64). During the third period, days 113-365, the intervention group had an insignificantly lower conclusion rate (HR 0.70, 95% CI 0.46-1.08, p = 0.10), and during the fourth follow-up period, days 366-1096, the intervention group had an insignificantly higher conclusion rate than the control group (HR 1.16, 95% CI 0.69-1.96, p = 0.58). Across the total follow-up period, the intervention group had a lower conclusion rate than the control group (HR 0.55, 95% CI 0.45-0.66, p < 0.0001).
No positive significant effects of the rehabilitation programme on time to sick leave conclusion were found.
Exercise medicine in cancer care.Australian Journal General Practice
Every four minutes, an Australian is diagnosed with cancer. Early detection and effective treatment means that many of these people are living with the side effects of cancer and its treatment for numerous years.
The aim of this article is to summarise the evidence examining the role of exercise in cancer care.
Exercise is a safe and effective adjunct therapy in cancer care. Patients with cancer who regularly engage in moderate-intensity exercise are more likely to have: fewer and less severe treatment-related side effects; a lower relative risk of developing other chronic diseases; and, in some cases, a lower relative risk of cancer recurrence and mortality. Available evidence highlights the benefits of general practitioners (GPs) discussing and recommending exercise to their patients with cancer. To optimise the therapeutic effect of exercise, GPs may consider referring patients with cancer to an exercise physiologist or physiotherapist who has experience in cancer care.
Physical activity for people with lung cancer.Australian Journal General Practice
International guidelines recommend exercise for all people with cancer. Effective supportive care interventions are required for people diagnosed with lung cancer to reduce morbidity associated with the disease process, frequently occurring comorbidities and treatment-related side effects.
This article summarises the evidence regarding the safety, effectiveness and patient experiences of exercise and physical activity interventions for people with lung cancer.
Exercise interventions for people with lung cancer are safe and effective at improving physical fitness, muscle strength and patient-reported outcomes including cancer-related fatigue, dyspnoea and health-related quality of life. Increasing evidence supports the use of exercise prior to treatment (prehabilitation) to improve outcomes following surgery. Individuals with lung cancer should be encouraged to be as physically active as possible. Throughout the patient's cancer journey, consideration and prescription of individualised exercise is an important component of care. General practitioners are well placed to coordinate this care, often in conjunction with exercise physiologists or physiotherapists.
Prescribing and dosing exercise in primary care.Australian Journal General Practice
Exercise prescription, while not traditionally part of the medical school curriculum or many advanced post-graduate training programs, is rapidly becoming an essential skill in primary care. Its importance relates to exercise being an effective evidence-based intervention for osteoarthritis, back pain, tendinopathy, some cancers, depression, diabetes and cardiovascular diseases.
The aim of this article is to describe the basic principles of exercise prescription in the context of a primary care medical consultation, assisting general practitioners to manage cases without the need for referral. Understanding the basic principles is important, but it should not be presumed that exercise prescription is always straightforward.
A good mantra for exercise prescription is 'move, monitor, modify'. Failure of basic exercise prescription does not necessarily mean that procedural or medication treatment is required, but instead second-line exercise prescription may be indicated. Although referral to an exercise-based practitioner is a useful option, exercise prescription should become embedded as part of primary care medical practice because of its reported effectiveness and minimal side effects when appropriately implemented.
Type 2 diabetes and the medicine of exercise: The role of general practice in ensuring exercise is part of every patient's plan.Australian Journal General Practice
The benefit of exercise in the prevention and management of type 2 diabetes (T2D) has a strong evidence base, so it is important to ensure exercise is part of every patient's management plan.
This article reviews the evidence for exercise in T2D and the factors affecting a patient's willingness to commence and sustain enough exercise to gain benefit. The article offers tips about how to safely and effectively prescribe the 'medicine' of exercise for all, even the frailest patients; who to stabilise before an exercise program should begin; and how to use the skills of an accredited exercise physiologist (AEP) to deliver the best 'prescription' possible.
General practitioners and their teams, along with other healthcare providers such as AEPs, can increase the amount of exercise medicine a patient receives. This is the case for those at risk of developing T2D, those with T2D and those with the many comorbidities associated with T2D.
Advances in prostate cancer.Australian Journal General Practice
Prostate cancer is a common tumour type in Australian men.
The aim of this article is to review important changes in prostate cancer diagnosis and management over the past five years, particularly as they pertain to general practice.
The management of prostate cancer has changed significantly in recent years, particularly the use of imaging, with the introduction of prostate magnetic resonance imaging as routine in the diagnostic pathway, and the increasing use of prostate-specific membrane antigen positron emission tomography for early stratification in the salvage setting for failure of primary treatment in localised disease. In addition, upfront combinations of androgen deprivation therapy with other systemic treatments have yielded significant gains in overall survival for patients with metastatic disease. There has also been an increasing recognition of the association between germline DNA repair defects and progressive disease, and interest in the potential to identify patients for therapies that target these defects. There have been significant changes in how prostate cancer is diagnosed and managed in the past five years, with the introduction of new clinical pathways that were unprecedented just a decade previously.
Current management of cerebral gliomas.Australian Journal General Practice
Despite their rarity, primary tumours of the central nervous system have a devastating impact on patient survival and quality of life. The classification of glial tumours has recently changed, and large trials have provided data on treatment impact; however, the treatment armamentarium remains the same, and many questions persist.
The aim of this narrative review is to discuss the current understanding and management of the most common glial brain tumours to equip general practitioners (GPs) and other non-neuro-oncological specialists with appropriate knowledge to share care and support patients.
Treatment of brain tumours is complex and multifaceted, and it involves many different specialists. Recent advances in translational research and molecular understanding of brain tumours raise hope that new treatments are imminent, and patients should be encouraged to participate in clinical trials. The GP has an important role in patient support and coordination of care.
Whole-person care in general practice: Factors affecting the provision of whole-person care.Australian Journal General Practice
Whole-person care (WPC) is a key characteristic of general practice, but it may not be consistently practised. Previous articles in this series suggest a model of WPC that views patients as multidimensional persons; has length, breadth and depth of scope; is founded on a strong doctor-patient relationship and involves a healthcare team. This article reports factors that general practitioners (GPs) believe affect their provision of WPC.
Semi-structured interviews were conducted with 20 Australian GPs or general practice registrars and analysed using grounded theory methodology.
Participants identified overarching factors (time, perceived value of WPC) and factors related to immediate (interpersonal dynamic), local (practice structure, relationship between care providers) and broader (health system structure) contexts that affect WPC. They volunteered practical suggestions to support WPC.
GPs believe that multiple factors acting at micro and macro levels affect WPC provision. These findings provide a basis for strategies to support WPC.
Links between perceived general practitioner support and the wellbeing of Australian patients with persistent pain.Australian Journal General Practice
Approximately one-fifth of the population have persistent pain of moderate-to-severe intensity, which affects patients physically, mentally, psychosocially and financially. The aim of this study was to investigate the association between self‑reported wellbeing of patients with persistent pain attending a pain clinic and perceptions of care from general practitioners (GPs) and other treating health professionals.
Patients with persistent pain completed a self-administered survey.
Overall, only 29 (35%) patients with persistent pain were satisfied with their overall wellbeing, with a positive sense of wellbeing solely predicted by a belief that their GPs are 'treating their problem sympathetically' (P = 0.001; prevalence odds ratio = 5.4; 95% confidence interval: 1.9, 14.9). Voluntarily disclosed free-form comments from patients with persistent pain also appear to indicate that GP-managed pain clinics may be able to provide a more consistent level of support and care to patients with persistent pain than other practice settings.
These findings suggest psychological support provided by GPs is an important factor for the maintenance of a positive sense of wellbeing for patients with persistent pain.